Effects of Concurrent Strength and Aerobic Exercise Training on Cognitive Health in Adults With Physiological or Neurocognitive Disorders: Systematic Review With Meta-analysis of Randomized Controlled Trials

Context: This study aimed to evaluate the effects of concurrent strength and aerobic exercise training (CET) on cognitive function in middle-aged and older adults with physiological conditions (e.g., type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic obstructive pulmonary disease, frailty, fibromyalgia) or neurocognitive disorders (e.g., mild cognitive impairment, dementia, Alzheimer’s disease [AD]). Evidence Acquisition: Two independent reviewers conducted a systematic search of PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, SPORTDiscus, CNKI, WanFang, and Google Scholar from inception to July 2024. Randomized controlled trials (RCTs) examining CET (≥4 weeks) in clinical populations, reporting global cognition via validated tools (e.g., Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA]). Non-RCTs, acute interventions, healthy populations, and lack of control were excluded. Two reviewers performed study selection, data extraction, and risk of bias assessment independently using the Cochrane Risk-of-Bias 2.0 tool; discrepancies were resolved by a third reviewer. Standardized mean differences (SMD) with 95% CI were calculated using random-effects models. Study Design: Systematic review and meta-analysis. Level of Evidence: Level II. Results: A total of 22 RCTs involving 3463 participants (age range, 43.9-92.1 years; 48% female) were included. Of these, 714 participants had physiological disorders (e.g., diabetes, fibromyalgia, frailty) and 2442 had neurocognitive disorders (e.g., dementia, AD). CET significantly improved global cognitive function compared with controls (SMD = 0.34; 95% CI, 0.18 to 0.50; P < 0.001; I 2 = 67%). Subgroup analyses demonstrated significant improvements in both physiological disorders (SMD = 0.29; 95% CI, 0.09 to 0.49; P < 0.01) and neurocognitive disorders (SMD = 0.37; 95% CI, 0.14 to 0.55; P < 0.01). No publication bias was detected (Egger’s test P = 0.62). Conclusion: CET is an effective nonpharmacological intervention for enhancing cognitive health in middle-aged and older adults with physiological or neurocognitive disorders. Strength-of-Recommendation Taxonomy (SORT): Moderate.